山东大学耳鼻喉眼学报 ›› 2021, Vol. 35 ›› Issue (4): 40-44.doi: 10.6040/j.issn.1673-3770.0.2020.385

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新生儿梨状窝瘘3例并文献复习

杨红,滕以书,李兰,潘宏光,梁振江,韩赛红   

  1. 深圳市儿童医院 耳鼻咽喉头颈外科, 广东 深圳 518035
  • 发布日期:2021-08-05
  • 通讯作者: 滕以书. E-mail:tys118@163.com

Pyriform sinus fistula in neonates: a clinical report of 3 cases and literature review

YANG Hong, TENG Yishu, LI Lan, PAN Hongguang, LIANG Zhenjiang, HAN Saihong   

  1. Department of Otorhinolaryngology & Head and Neck Surgery, Shenzhen Children's Hospital, Shenzhen 518035, Guangdong, China
  • Published:2021-08-05

摘要: 目的 总结新生儿梨状窝瘘的临床特点及诊治经验。 方法 对2018年1月至2020年9月诊治的3例新生儿梨状窝瘘的临床表现、辅助检查、治疗方法及预后进行回顾性分析。 结果 3例梨状窝瘘患儿中男孩2例,女孩1例,其中1例男性患儿出生后10 d即被发现颈部肿物而就诊,余两例患儿产前检查被发现;3例梨状窝瘘均在左侧;3例病例颈部B超均显示颈部囊性团块,囊壁厚,囊腔内显示点状气体样回声,颈部增强CT提示囊腔内见气液平。3例患儿均行手术治疗,其中两例新生儿术中切除肿物后明确找到瘘管,予以顺利结扎,梨状窝处内瘘口未予以特殊处理,另1例颈部肿物予以切开引流后内镜下激光烧灼内瘘口。术后随访5个月至两年,暂未发现复发或反复感染病例。 结论 新生儿常以出生后发现无痛性颈部肿物或产前发现颈部占位为表现,颈部B超及颈部CT检查示肿物中常可见气体影,出生后肿物进行性增大,这时需高度怀疑梨状窝瘘可能。手术治疗是根除梨状窝瘘的根本方法,内镜下激光烧灼内瘘口和颈部肿物切除后高位结扎瘘管均未见复发。

关键词: 梨状窝瘘, 新生儿, 颈部肿物, 气体影

Abstract: Objective To summarize the clinical characteristics, diagnosis and treatment of pyriform sinus fistula in neonates. Methods The clinical manifestation, auxiliary examination, treatment and prognosis of 3 cases of pyriform sinus fistula in our department were analyzed retrospectively between January 2018 and June 2020. Results 3 cases of pyriform sinus fistula were reported, there were 2 boys and 1 girl. One male child was found to have neck tumor 10 days after birth, and the other two cases were found in prenatal examination; 3 cases of pyriform sinus fistula were all on the left side; 3 cases of neck B-ultrasound showed cystic mass in the neck, with thick wall, punctate gas echo in the cavity, and enhanced CT showed gas-liquid level in the cavity. All the 3 cases were treated by operation. Two of them were founded the fistula after removing the tumor and ligated it smoothly. The internal fistula of pyriform sinus was not treated specially. The other one was cut and drained and then cauterized by laser under endoscope. The patients were followed up for 5 months to 2 years after surgery. No recurrence or repeated infection was found. Conclusion The neonatal pyriform sinus fistula usually starts with painless neck mass or is founded in prenatal examination. B-ultrasound and CT examination of the neck showed that the masses were often seen Gas shadow, progressive enlargement of tumor after birth, At this time, we need to highly suspect the pyriform sinus fistula. Surgical treatment is the fundamental method to eliminate the pyriform sinus fistula. No recurrence was found in the laser cauterization of the internal fistula and high ligation of the fistula after removal of the neck mass.

Key words: Pyriform sinus fistula, Newborns, Neck mass, Gas shadow

中图分类号: 

  • R762
[1] James A, Stewart C, Warrick P, et al. Branchial sinus of the piriform Fossa: reappraisal of third and fourth branchial anomalies[J]. Laryngoscope, 2007, 117(11): 1920-1924. doi:10.1097/mlg.0b013e31813437fc.
[2] 董锦锦, 田秀芬. 先天性梨状窝瘘的诊断与治疗经验探讨[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(6): 444-447. doi:10.3760/cma.j.issn.1673-0860.2018.06.011. DONG Jinjin, TIAN Xiufen. Experience of diagnosis and treatment for congenital pyriform sinus fistula[J]. Chin J Otorhinolaryngol Head Neck Surg, 2018, 53(6): 444-447. doi:10.3760/cma.j.issn.1673-0860.2018.06.011.
[3] Watson GJ, Nichani JR, Rothera MP, et al. Case series: Endoscopic management of fourth branchial arch anomalies[J]. Int J Pediatr Otorhinolaryngol, 2013, 77(5): 766-769. doi:10.1016/j.ijporl.2013.02.007.
[4] 肖现民, 曾纪骅, 金百祥. 儿童梨状窝瘘的诊断与处理[J]. 中华外科杂志, 1997, 35(6): 354-356. XIAO Xianmin, ZENG Jihua, JIN Baixiang. Diagnosis and management of piriform sinus fistulae in children [J]. Chiese J Surg, 1997, 35(6): 354-356.
[5] Hosokawa T, Yamada Y, Sato Y, et al. Five neonatal cases of pyriform sinus fistula with cervical cystic lesion: a comparison between sonography and other modalities[J]. J Med Ultrason(2001), 2015, 42(4): 579-585. doi:10.1007/s10396-015-0641-5.
[6] Sheng QF, Lv Z, Xu WJ, et al. Differences in the diagnosis and management of pyriform sinus fistula between newborns and children[J]. Sci Rep, 2019, 9(1): 18497. doi:10.1038/s41598-019-55050-9.
[7] 李清明, 吴思恩, 黄素红, 等. 第三腮裂瘘管诊治6例并文献复习[J]. 山东大学耳鼻喉眼学报, 2016, 30(3): 61-64. doi:10.6040/j.issn.1673-3770.0.2016.041. LI Qingming, WU Sien, HUANG Suhong, et al. Diagnosis and treatment of the third branchial cleft fistula: a clinical report of 6 cases and literature review[J]. J Otolaryngol Ophthalmol Shandong Univ, 2016, 30(3): 61-64. doi:10.6040/j.issn.1673-3770.0.2016.041.
[8] 付营慧, 闵翔, 龙平, 等. 先天性梨状窝瘘的手术治疗和临床解剖学探讨[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(13): 984-987. doi:10.13201/j.issn.1001-1781.2018.13.006. FU Yinghui, MIN Xiang, LONG Ping, et al. The anatomic characteristics and surgical treatment of congenital pyriform sinus fistula[J]. J Clin Otorhinolaryngol Head Neck Surg, 2018, 32(13): 984-987. doi:10.13201/j.issn.1001-1781.2018.13.006.
[9] Nicoucar K, Giger R, Pope HG, et al. Management of congenital fourth branchial arch anomalies: a review and analysis of published cases[J]. J Pediatr Surg, 2009, 44(7): 1432-1439. doi:10.1016/j.jpedsurg.2008.12.001.
[10] 黄舒玲, 梁璐, 陈良嗣. 先天性梨状窝瘘的外科治疗进展[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(18): 1491-1494. doi:10.13201/j.issn.1001-1781.2016.18.017. HUANG Shuling, LIANG Lu, CHEN Liangsi. Progress in surgery treatment of congenital pyriform sinus fistula[J]. J Clin Otorhinolaryngol Head Neck Surg, 2016, 30(18): 1491-1494. doi:10.13201/j.issn.1001-1781.2016.18.017.
[11] 杜林芳, 路武豪, 娄卫华, 等. 内镜辅助下内瘘口封闭术治疗先天性梨状窝瘘管的疗效分析[J]. 中国耳鼻咽喉头颈外科, 2017, 24(12): 651-652. doi:10.16066/j.1672-7002.2017.12.013.
[12] Wang L, Sang J, Zhang Y, et al. Evaluation of endoscopic coblation treatment for obliteration of congenital pyriform sinus fistula[J]. Acta Otolaryngol, 2018, 138(6): 574-578. doi:10.1080/00016489.2017.1420916.
[13] Wang SC, He YZ, Zhang YM, et al. CO2 laser cauterization approach to congenital pyriform sinus fistula[J]. J Pediatr Surg, 2018, 53(7): 1313-1317. doi:10.1016/j.jpedsurg.2017.06.020.
[14] Yanagisawa S, Oshio T, Kato M, et al. Endoscopic chemocauterization for pyriform sinus fistula in children[J]. Pediatr Int, 2017, 59(7): 807-811. doi:10.1111/ped.13294.
[15] 李玉晓, 何晓光, 王雨, 等. 第三、四鳃裂畸形的临床特征及疗效分析[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(15): 1201-1205. doi:10.13201/j.issn.1001-1781.2016.15.006. LI Yuxiao, HE Xiaoguang, WANG Yu, et al. Clinical characteristics and surgical management in patients with third and fourth branchial anomalies[J]. J Clin Otorhinolaryngol Head Neck Surg, 2016, 30(15): 1201-1205. doi:10.13201/j.issn.1001-1781.2016.15.006.
[16] Noriko Hamaguchi, Hajime Ishinaga, Kazuki Chiyonobu, et al. A case of pyriform sinus fistula with respiratory distress in the neonatal period[J]. Case Rep Otolaryngol, 2018, 2018: 1696875. doi:10.1155/2018/1696875.
[17] Derks LS, Veenstra HJ, Oomen KP, et al. Surgery versus endoscopic cauterization in patients with third or fourth branchial pouch sinuses: a systematic review[J]. Laryngoscope, 2016, 126(1): 212-217. doi:10.1002/lary.25321.
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